REPORT: Department of Ophthalmology, University Hospital Bern, Switzerland
The Bern approach for organizing the medical and surgical retina service in the context of the COVID-19 pandemic.
Our approach is based on the principle that patient and doctor/staff safety is our priority. We try to balance between patient’s risk of irreversible visual loss without treatment and the increased risk of SARS-CoV-2 infection by attending the eye department. The Swiss Government has released on March 13, 2020 a COVID-19 Ordinance. This ordinance prohibits all healthcare providers to carry out non-urgent medical examinations, treatment and therapies (medical procedures). Based on this we defined urgent medical examinations and treatments for medical and surgical retina patients as follows
Urgent surgical conditions
– Retinal detachment
– Vitreous hemorrhages not secondary to vascular diseases (e.g. diabetic retinopathy, retinal vascular occlusions…)
– Open globe trauma
Urgent medical conditions
In general, all patients will be informed before the appointment, that they should postpone their appointment in case of a respiratory infection (sore throat, cough, fever, vomiting) and if they have had contact to a COVID-19 positive case within the last 2 weeks. Additionally, they are informed, that all accompanying persons have to wait outside the eye department.
– To minimize contact between patients and health personal, we omit OCT examination and vision measurements. During the injection procedure the patient is asked if vision was stable since the last injection. If no severe vision loss is reported, the last injection interval will be maintained. In case of severe vision loss, the injection interval is reduced to 4 weeks.
– All intravitreal injections for CNV secondary to AMD and other diseases, macular edema secondary to retinal vein occlusion are urgent and cannot be delayed. In patients with diabetic macular edema the urgency depends on the individual situation.
– Case by case basis decision if appointments can be delayed by 3 months.
– Patients with PDR requiring treatment will be treated with intravitreal injections every 8 weeks to postpone necessary panretinal laser coagulation.
– Patients with acute vision loss will be reviewed using OCT and wide field colour photography and contact at the slip limp will be minimized
– Non-contact (air puff) tonometer has to be avoided
– All health professionals are wearing masks during contact with patients
– Slit lamp are fitted with a breath guard
– Social distancing is respected in all waiting areas, the number of seats is reduced